Holistic nursing research

HOLISTIC
NURSING
RESEARCH
MAYBELLE B. ANIMAS

A systematic inquiry or
investigation to validate and
refine existing knowledge and
generate new knowledge about all
nursing practice that has healing
the whole person as its goal
Holistic Nursing Research

Evidence-based Practice
The current mandate to use the best
evidence in our clinical decisions is driven
by the goal of achieving effective
patient outcomes and making a
positive difference in the lives
of our patient.

Two strategies:
• Research utilization
• Evidence-based practice

Two strategies:
• Research utilization
– Using research in practice in a way that
resembles how it was done in the original
research study.

Two strategies:
• Evidence-based practice
– Careful deliberation use of the best available
evidence for making decisions about patient
care.

Meta-analysis
statistical technique that establishes an
overall estimate of the therapeutic
effectiveness of an intervention by
combining the results of many
experiments related to that intervention.

Selection of studies :
The search strategy returned a total of 7671
hits. After eliminating irrelevant and
duplicate studies, 740 studies remained.

Conclusion
There is consistent and conclusive
evidence that massage therapy is
generally safe.

Need to Conduct Holistic
Research
• Research provides the direction for
selecting interventions with proved
effectiveness.
• Research determine the effectiveness of
our interventions on patient outcomes.
• Research investigates the outcome of
healing on individuals

Quantitative Research
• Systematic formal,
objective process in
which numerical data
are used to obtain
information about the
world.

• Systematic,
subjective form of
research that is used
to describe life
experiences and give
them meaning.

Abstract
This study explored the experiences of parents of
children with cerebral palsy undergoing surgery as
they describe them from a lived experience
perspective. When children undergo surgical
procedures, they have to stay at hospital for a long
time, which represents a great challenge for the
children as well as their parents.

Abstract
Parents experienced demanding challenges as they
entered the hospital, in a situation that meant both
familiarity and unfamiliarity. Judgments about how to
care for the child relied on what they normally did. Sitting
bedside for hours and days, thoughts about the
legitimacy of letting their child go through the suffering
surgery were tormenting the parents. They felt
vulnerable and very much dependent on health care
workers’ competence and at the same time doubting
them in seeing and taking care of their child's specific
needs.

Methodology
We collected data by using open-ended interviews
with 12 parents of 9 children and analyzed these data
in accordance with Max van Manen's methodological
themes, a method that is both descriptive and
interpretive.

Enhancing Holistic Research
Triangulation
use of multiple research techniques to
collect and evaluate data on a specific
topic in order to converge on a complete
representation of reality and confirm the
credibility of the research findings.

Triangulation
Data Source Triangulation
-strengthens the rigor of the research by
using several sources of data to assess a
single clinical phenomenon

Example:
In a large capital city, three different nongovernmental
organizations (NGOs) run comprehensive prevention projects
for hotel-based sex workers. Each programme works in a
different part of the city where there are multiple hotels that
rent space to sex workers and their clients. The projects are
generally similar, but the dynamics in each community are
slightly different. Triangulating performance data from across
these three projects e.g. frequency of contact with sex workers,
percentage of sex acts including proper use of a condom,
reduction in prevalence of sexually transmitted infection among
sex workers will provide a much clearer picture of the overall
situation than simply reviewing the data from one programme
and attempting to extrapolate broader lessons from those data.

Triangulation
Methodologic Triangulation
-Combining multiple methods to gather
data, such as documents, interviews,
observations, questionnaires or surveys,
when conducting primary research, at
different times and in different places

ABSTRACT
The study wishes to explore the lived experiences of
nurses caring for a patient with a Do-Not-Resuscitate
(DNR) order in the year 2010 among tertiary hospitals in
Cebu City, Philippines in the year 2010. Moreover, the
study probes if there was a change in the quality of nursing
care after the order was consented, the reasons for it as
well as the true feelings of the nurses and the possible
consequences of it towards their personal and professional
roles.

Methods
The design is a phenomenological study which was
done through a triangulation -the formation of a
primary, focus and narrator groups respectively.
Data gathering was done through a narrative
accounts of informal interviews, an audio-video
recording, a checklist, and through validation
groups through patient accompanying and other
nurses which are not a part of any of the groups
stated

Results and Discussion
There were varying degrees of views that nurses have
why they changed their views after the Do-Not-
Resuscitate Order and the two most common reasons
were, they donot want to place more burden on the
sacrificing and struggling patient while the other was
although these patients have limited time to leave, they
still deserve the full rights of being cared for justly. Out
from these responses, the common themes formulated
out of the responses are patient attachment, conflicting
roles, hopelessness, perceived incompetence, conscience
and idealism and work exhaustion which need to be
addressed and given emphasis.

Conclusions
It was found out in the study that nurses do have a change in
the way they view their patient’s after their relatives consented
to a Do-Not-Resuscitate. But these changes do not merely
mean tardiness or the lack of motivation but with a very
humanitarian reason of not imposing and preventing the risk of
adding additional burden towards the agonizing and suffering
patient. They believed that the more they give not that essential
yet exhausting interventions might shorten the patients living
hours.
It is further concluded that changes in the quality of care happen
intentionally for the reason of giving the allotted time into other
patients who have greater chances of survival and not a the
same order as the former is.

Triangulation
Theory triangulation:
-Using more than one theoretical approach
(theory) to interpret and support data

Background
Language development is one of the most significant
processes of early childhood development. Children with
delayed speech development are more at risk of acquiring
other cognitive, social-emotional, and school-related
problems. Music therapy appears to facilitate speech
development in children, even within a short period of time.
The aim of this pilot study is to explore the effects of music
therapy in children with delayed speech development.

Methods
A total of 18 children aged 3.5 to 6 years with delayed
speech development took part in this observational study
in which music therapy and no treatment were compared
to demonstrate effectiveness. Individual music therapy
was provided on an outpatient basis. An ABAB reversal
design with alternations between music therapy and no
treatment with an interval of approximately eight weeks
between the blocks was chosen. Before and after each
study period, a speech development test, a non-verbal
intelligence test for children, and music therapy
assessment scales were used to evaluate the speech
development of the children.

Results
Compared to the baseline, we found a positive
development in the study group after receiving music
therapy. Both phonological capacity and the children's
understanding of speech increased under treatment, as
well as their cognitive structures, action patterns, and
level of intelligence. Throughout the study period,
developmental age converged with their biological age.
Ratings according to the Nordoff-Robbins scales showed
clinically significant changes in the children, namely in
the areas of client-therapist relationship and
communication.

Conclusions
• This study suggests that music therapy may have a
measurable effect on the speech development of
children through the treatment's interactions with
fundamental aspects of speech development, including
the ability to form and maintain relationships and
prosodic abilities. Thus, music therapy may provide a
basic and supportive therapy for children with delayed
speech development. Further studies should be
conducted to investigate the mechanisms of these
interactions in greater depth.

• Background
• Dance therapy or dance movement therapy is defined as
“the psychotherapeutic use of movement as a process
which furthers the emotional, social, cognitive, and
physical integration of the individual.” It may be of value
for people with developmental, medical, social, physical,
or psychological impairments. Dance therapy can be
practiced in mental health rehabilitation units, nursing
homes, and day care centers and incorporated into
disease prevention and health promotion programs.

Objective
To evaluate the effects of dance therapy for people
with schizophrenia or schizophrenia-like illnesses
compared with standard care and other interventions.
• Search Methods
We searched the Cochrane Schizophrenia Group Trials
Register (July 2007), inspected references of all
identified studies (included and excluded), and
contacted first authors for additional data.

Selection Criteria
We included all randomized controlled trials
comparing dance therapy and related approaches with
standard care or other psychosocial interventions for
people with schizophrenia.
• Data Collection and Analysis
• We reliably selected, quality assessed, and extracted
data. We excluded data where more than 30% of
participants were lost to follow-up. For continuous
outcomes, we calculated a weighted mean difference
(WMD); for binary outcomes, we calculated a fixed-effect
risk ratio (RR) and their 95% confidence intervals (CIs).

• Results
• We included one single blind study (total n=45) of reasonable quality
(tables 1 and and22).1It compared dance therapy plus routine care
with routine care alone. Most people tolerated the treatment
package, but about 40% were lost in each group by 4 months (RR =
0.68, 95% CI = 0.31 to 1.51). Positive and Negative Syndrome
Scale (PANSS) average endpoint total scores were similar in each
group (WMD = −0.50, 95% CI = −11.8 to 10.8) as were the positive
subscores (WMD = 2.50, 95% CI = −0.67 to 5.67). At the end of
treatment, significantly more people in the dance therapy group had
a greater than 20% reduction in PANSS negative symptom score
(RR = 0.62, 95% CI = 0.39 to 0.97) (figure 1), and overall average
negative endpoint scores were lower (WMD = −4.40, 95% CI =
−8.15 to 0.65). There was no difference in satisfaction score
(average Client's Assessment of Treatment Scale score, WMD =
0.40, 95% CI = −0.78 to 1.58), and quality-of-life data were also
equivocal (average Manchester Short Assessment of Quality of Life
score, WMD = 0.00, 95% CI = −0.48 to 0.48).

• AUTHORS' CONCLUSIONS:
• There is no evidence to support - or refute - the use of
dance therapy in this group of people. This therapy
remains unproven and those with schizophrenia, their
carers, trialists and funders of research may wish to
encourage future work to increase high quality evidence
in this area

Holistic nursing research

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